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The problems of ossicular reconstruction in chronic ear surgery have led to the development of new ossicular replacement prostheses. Improvements in biocompatibility and design led to the development of hydroxylapatite hybrid (HaH) ossicular replacement prostheses. The senior author's (M.E.G.) experience with the Black HaH prostheses is reviewed. Sixty cases are grouped by procedure and prosthesis (19 TORPs and 41 PORPs) with a minimum follow-up of 1 year. Audiometric data are analyzed to determine the success rate in air-bone gap closure. Complication and extrusion rates are reviewed. These results are compared against those obtained using other prostheses using similar criteria, and this report serves as a follow-up on a previous paper on this subject by the senior author.

The purpose of this report is to review the outcomes of patients undergoing stapes surgery by the senior author during the past 25 years, and to compare these results with those obtained in other series. A retrospective analysis of 902 patients who underwent stapes surgery by the senior author from 1970 to 1994 was performed. Twenty-two patients underwent stapedotomy; the remainder underwent stapedectomy. Pure-tone averages for air and bone conduction, air-bone gap closure, technique, complications, and patient satisfaction were compared with results obtained in other stapedectomy and stapedotomy series.

Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors; 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores. Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach. The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.

Intracranial extension (ICE) is the spread of tumor into the subarachnoid space through dura or along cranial nerve roots. The single-stage removal of the skull base tumor with its ICE has been confounded by cerebrospinal fluid management and defect reconstruction. The purpose of this report is to review a current protocol for managing the cranial base tumor and its ICE as a unit. The ventricular shunting paper of 1987 is retracted. All tumors were managed at a single stage. Defect reconstruction was size dependent. Ninety-eight neurotologic skull base tumors with ICE were managed from 1971 to 1991. The new protocol was initiated in 1987. Results specific to this group are highlighted. For glomus tumors, cerebrospinal fluid leak rates have been dramatically reduced overall from 14.5% to 4%. The leak rates for nonglomus tumors, overall, have improved slightly. Complications are discussed. The development of this surgical approach protocol improves the functional outcome in patients of surgeons who aspire to disease "cure" rather than "control."